Category Archives: Antibiotic News

A tapered and pulsed regimen with vancomycin — with diligent follow-up — can achieve significant cure rates in recurrent Clostridium difficile (C. difficile) infected patients, according to a new study.

Researchers from Loyola Medicine retrospectively studied 100 vancomycin taper and pulse treatment patients treated for recurrent C. difficile infection between January 1, 2009 and December 31, 2014. Their clinic, the study authors wrote, has been a referral center for the infection for the past decade.

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However, despite the guidelines for treatment of recurrent C. difficile infection being not too different than recurrent episodes – except for the use of vancomycin when the case is severe – there have not been many studies on this vancomycin taper and pulsed dosing.

The researchers observed that after a referral, the confirmed recurrent C. difficile patients were treated with a vancomycin taper and pulse regimen: a taper of vancomycin to once-daily, followed by alternate day dosing; or once-daily followed by alternate day dosing; followed by every third day, for at least 2 weeks. After this regimen, all patients had 90-day follow-up documentation.

On average, the patients in the clinic were on their third C. difficile diarrhea episode. Half of the patients had also received a standard course of vancomycin, while another third had received some type of vancomycin taper regimen, the researchers said.

Despite the fact that many of these patients were a “treatment experienced” population, 75% of the patients who received a supervised vancomycin taper and pulsed regimen achieved a cure, study author Stuart Johnson MD, . He added that the results were further improved for patients who received the expended pulse phase: 81% achieved a cure.

“The findings were not unexpected to us, but I think that many clinicians will be surprised how well a deliberate, prolonged vancomycin taper and pulse regimen – with careful follow up – works,” Johnson said.

There were no significant differences among the patients in terms of gender, age, concomitant antibiotics, proton pump inhibitor use, histamine receptor-2 blocker use, or patients with a regimen greater than 10 weeks in length, the researchers continued.

The researchers added that their finding of improved cure rates with alternate-day dosing plus every third day dosing over strictly alternate-day dosing is consistent with the hypothesis that pulsed dosing can promote a cyclical decrease in spore burden, they wrote. This can also permit the resetting of normal microbiota in the gut.

Johnson concluded that the clinical implications of the study show most recurrent C. difficile patients do not need fecal microbiota transplant (FMT).

“FMT has received an enormous amount of press and this procedure is now widely available throughout the US,” Johnson said. “FMT is attractive because it addresses one of the primary mechanisms involved with recurrent C. difficile infection, a marked disruption of the resident bacteria that populate the intestine and provide an important host defense against C. difficile.

Although physicians screen donor feces for “known pathogens,” not all is known of the potential complications to come from FMT, Johnson said.

“In addition, it appears that efficacy with a carefully supervised vancomycin taper and pulse regimen compare to that achieved with FMT,” Johnson said.

About 2 million Americans catch drug-resistant infections each year, and 23,000 die, according to the CDC.

As superbugs capture attention as a worldwide health threat, Washington University will be part of a national campaign against drug-resistant bacteria with a $2 million federal grant. The Centers for Disease Control and Prevention awarded $14 million to 25 medical schools and other organizations for research into how microorganisms in the body, known as the microbiome, can track and prevent infections by outsider, drug-resistant germs.

“Understanding the role the microbiome plays in antibiotic-resistant infections is necessary to protect the public’s health,” Dr. Tom Frieden, CDC director, said in a statement. “We think it is key to innovative approaches to combat antibiotic resistance, protect patients, and improve antibiotic use.”

The microbiome includes “good” bacteria and other beneficial organisms that live in the skin and in the digestive and respiratory tracts. Antibiotics that are supposed to fight “bad” bacteria can disrupt the natural habitat by unbalancing the good and bad. Then drug-resistant bacteria can take over and create an environment for out-of-control bugs, including methicillin-resistant staphylococcus aureus (MRSA), carbapenem-resistant enterobacteriaceae (CRE) and clostridium difficile (C. diff.).

Overexposure to antibiotics has been blamed for the rise in superbugs, with the CDC estimating that one in three antibiotic prescriptions is unnecessary.

The research project will look at how early exposure to antibiotics affects the development of the microbiome and whether there are better ways to protect the microbiome.

Four teams of researchers at Washington University were named to the local project:

Dr. Jeffrey Henderson will lead a team working to identify how diet and metabolism interact with the gut microbiome in a study to combat C. diff. intestinal infections.

A team led by Gautam Dantas will study the long-term effects of antibiotic therapy in premature infants and how their digestive microbiomes are affected.

Dr. Jennie Kwon will study antibiotics and the microbiome as it relates to pneumonia.

Dr. Brian Gage will help look at hemorrhages linked to the use of blood thinners.

The United Nations General Assembly focused on superbugs — in a rare discussion of health issues. The meeting comes after a new superbug resistant to last-resort antibiotics infected a Pennsylvania woman over the summer, and a resistant strain of E. coli was recently found in a 2-year-old Connecticut girl.

The CDC recommends increased testing for the superbug gene among certain types of E. coli bacteria that show resistance to the powerful antibiotic colistin. The gene spreads readily among bacteria, and it could make these multi-drug-resistant strains almost impossible to treat.

A cluster of gonorrhea infections in Hawaii has shown resistance to all treatments. Doctors are increasingly worried that the common sexually transmitted disease is gaining strength as one of the most urgent superbug threats. If untreated, the disease can lead to infertility.

At least 30 percent of antibiotics are unnecessarily prescribed, contributing to the rise of debilitating and sometimes deadly bacteria-resistant superbugs, according to a study released Tuesday – May 3, 2016.

To reach this conclusion, researchers tracked antibiotic use in doctors’ offices and emergency departments between 2010 and 2011 throughout the United States. The study results were published in Journal of the American Medical Association by the Centers for Disease Control and Prevention along with Pew Charitable Trusts.

The findings showed that doctors needlessly wrote prescriptions for viruses, such as the common cold, viral sore throats and other ailments that can’t be cured with antibiotics. More than 47 million excess prescriptions put patients in harm’s way for allergic reactions and superbugs, such as Clostridium difficile, or C. diff.

“The rampant misuse of antibiotics is probably the leading infectious disease public health threat the world faces,” Dr. Amesh Adalja, a UPMC infectious disease specialist, said after learning of the study results. “The spread of antimicrobial-resistant bacteria and the infections they cause are a crisis and, if allowed to continue, will drag civilization back decades.”

Superbugs kill 23,000 Americans a year and sicken 2 million, according to the CDC.

Last year, the White House set its sights on superbugs, releasing a plan to combat the proliferation of antibiotic-resistant bacteria. The plan’s goal is to reduce outpatient antibiotic use by 50 percent and inpatient use by 20 percent by 2020.

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You can customize maps and tables to show antibiotic resistance patterns in Healthcare-Associated Infections (HAI’s) by filtering the data by geographical area (national, regional, and state), time period, event type, and patient age.

A new blood test developed by researchers in North Carolina has been shown to distinguish between viral and bacterial infections.

The blood test has been designed to measure the gene expression of certain components of the immune system, which should allow doctors to identify whether the infection a patient is suffering from is bacterial or viral.

This distinction is crucial, as bacterial infections can be treated with antibiotics, whereas viral infections cannot, and prescribing antibiotics for viral infections only adds to the growing problem of antibiotic resistance.

‘Antibiotic resistance has been described as ‘one of the biggest health threats of our time’…’

Antibiotic resistance has been described as ‘one of the biggest health threats of our time’, and bold warnings have been issued explaining that if we do not refine our use of the drugs, in the future we may no longer be able to perform routine operations or use chemotherapy, and many could end up dying from illnesses commonly treatable today.Antibiotics work by targeting properties of bacteria that are unique and fundamental to them, such as blocking their ability to synthesize proteins or damaging their cell wall. The reason antibiotics can work so well is because the properties we target have no counterparts in human cells and therefore treatment can be given with minimal side effects on ourselves.

The problem of resistance arises as bacteria mutate, and there are a number of ways in which bacteria can do this. One way bacteria can counter the effects of antibiotics is by altering the drug’s target, such as the cell wall, so it is no longer vulnerable to the antibiotic. Bacteria can also create enzymes which inactivate the antibiotic or can create a ‘pump’ to remove the drug from their cells.

It only takes a single bacterium to acquire one of these changes to result in an antibiotic resistant infection. Bacteria multiply at a very fast rate and thus if even one bacterium mutates, and the antibiotic clears every other normal bacterial cell involved in the infection, that single mutated bacterium can rapidly divide, increase in numbers resulting in an antibiotic resistant infection.

‘The overuse of antibiotics makes it far more likely that bacteria will acquire mutations that make them resistant…’

An astounding 50% of antibiotics prescribed are given to patients in unnecessary circumstances, such as in viral infection. The properties of viruses are very different to bacteria and therefore antibiotics are ineffective against infections caused by viruses. The overuse of antibiotics makes it far more likely that bacteria will acquire mutations that make them resistant, meaning our antibiotics are slowly but surely becoming ineffective.

The new blood test developed by scientists at Duke University in North Carolina managed to distinguish between bacterial and viral infection with an accuracy of 87% in a study on 317 patient blood samples.

Here in the UK, the Longitude Prize, a £10 million grant, was chosen by the public to be invested in antibiotic research with the aim to design a test that will conclusively distinguish between bacterial and viral infection.

The new blood test in question could provide a good foundation for further research to be done, allowing conclusive and accurate diagnosis of bacterial infection. Unfortunately, the blood test requires ten hours of analysis and so would be of minimal use in a GP environment where most over-prescription takes place. However, with the Longitude Prize pushing for new research into a quick and easy test to confirm bacterial infection, this new blood test has the potential to do big things for such a topical issue.

Did you have the opportunity to listen to the live broadcast on “C. diff. Spores and More Global Broadcasting Network” on Tuesday, February 9th, 2016 with guests Dr. Lori Hicks and Dr. Arjun Srinivasan from the Centers of Disease Control and Prevention (CDC) ?

Dr. Hicks and Dr. Srinivasan discussed how to use antibiotics wisely and how everyone can help in the fight against antibiotic-resistance.

This important information is now available to you on demand by clicking directly on the logo below

For additional information on Inpatient Antibiotic Stewardship please click on the following link:

Exposure to specific antibiotics is linked to the development of certain strains of antibiotic-resistant C. difficile, one of the fastest growing bacteria superbugs, according to a new study published by Stuart Johnson, MD, of Loyola University Health System (LUHS),Loyola University Chicago Stritch School of Medicine (SSOM) and the Hines VA Medical Hospital.

“This discovery takes us one step closer to preventing C. diffand supports targeting specific antibiotics for antibiotic stewardship monitoring programs in the setting of high infection rates due to specific strains of C. diff,” said Dr. Johnson, the lead author, who reported the findings of the retrospective C. diff case control study in Antimicrobial Agents and Chemotherapy.

C. diff has been associated with multiple healthcare facility outbreaks and high national rates of C. difficile infection (CDI) since 2001 and now rivals Methicillin-resistant staphylococcus aureus (MRSA) in both frequency and severity.

Several infectious diseases, including MRSA and C. diff,have become resistant to antibiotics.

As a result, the medical community has deliberately reduced the routine practice of prescribing antibiotics for infectious diseases.

There currently is not a highly effective prevention method for C. diff.

“Antibiotic exposure is arguably the most important risk factor for C. difficile infection (CDI),” Johnson wrote.

“We know that antibiotics wipe out beneficial flora in the gut, making patients susceptible to a C. diff infection.

The other role of antibiotics highlighted in our study is that overuse of specific antibiotics may facilitate infection due to C. diff strains that are highly resistant to those antibiotics.”

Dr. Johnson and a team that included his longtime research partner, foremost C. diff expertDale Gerding, MD, LUHS, SSOM, identified 143 patients with first episode CDI between 2005 and 2007 in one U.S. hospital at a time when increased CDI rates and severity were noted nation-wide.

Of those 103 patients, or 72 percent, were infected with the BI/NAP1/027 C. diff strain, which is highly resistant to fluoroquinolones and macrolides.

Most patients received multiple antibiotics within six weeks of being diagnosed with CDI. Fluoroquinolone and macrolide exposure was more frequent in patients with B1 strains, and the C. difficile bacteria recovered from the stool specimens of these BI-infected patients also showed high-level resistance to these antibiotics.

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